Preparing for a Good Death: Saying Goodbye
By Loh Yan Zhu
Often, a death of a loved one shaped how we view life and death thereafter. If the experiences were positive, we would be able to view and accept death as a way of life or as a celebration of a good life. Conversely, if the experiences were negative, we would probably view death as something fearful and unmanageable.
My first experience with death impacted me significantly. I was a caregiver for my younger brother who was born with congenital heart condition - he was born with two holes in the heart and had several surgeries as a baby. Since then, he was homebound and had special needs. He passed away at the age of 15 during the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003 as he could not receive timely medical support due to hospitals being wary of unnecessary visits. I remembered being very angry with myself for not looking out for him, not observing his health status closely and blaming the many SARS precautionary measures for causing the death of my beloved brother.
Little did I expect that this experience would impact me greatly as I battled with guilt and regret for not being able to say goodbye during his last moments. I often wondered if he had a peaceful death, why did he not say any parting words to me. Was he angry with me for not caring for him enough? Till today, I do not have answers to any of these questions.
COVID-19 outbreak brought a floodgate of memories of him back to my mind. This time round, I reflected as a counsellor and started to think about families that might have similar experiences as I did. I wondered what would have helped my brother to have a good death and caregivers (like myself) feel less guilty and hurt.
The answer is to make the conscious choice in preparing ourselves and our loved ones for departure. Dying is inevitable but we can all prepare for a good death.
From my work with palliative clients and caregivers, the common answers on what a good death constitutes are lesser suffering, manageable pain and being free from avoidable stressors for self, family and friends. Hence to achieve a good death, we can think of it in four main areas:
1. Biological aspect: This comprises reducing physiological sufferings such as pain and discomfort. We can plan for end-of-life care arrangements, complete our Advance Care Planning (ACP) and Lasting Power for Attorney (LPA). This ensures that our loved ones know what to expect and our preferences of care so they can act on our best interest.
2. Social aspect: Communicate with our family and friends about our needs and preferences for end-of-life. Do we want visitations? Whose company do we hope for and what can our loved ones do for us? Or even preparing gifts for our loved ones? This can help alleviate unnecessary stressors and anxieties towards the last goodbye.
3. Spiritual aspect: We can discuss about our funeral arrangement and religious rites preferences. Communicate our choice of hymns or sutra, funeral environments, types of burial, and placement of tablet to our loved ones can provide a sense of comfort and peace for all.
4. Psychological aspect: This focuses on managing anxieties, fears and uncertainty towards dying. It is also important to foster meaningful end-of-life conversation between us and our loved ones. This will help prepare not just you, but also your loved ones to be ready when the time comes to say goodbye.
During my counselling experience with palliative clients, I often hear these three top regrets from my clients,
- Not saying “I love you” enough.
- Not spending enough quality time with loved ones and friends.
- Not forgiving / seeking forgiveness from others.
Ironically, most of us only start to think of what we did not do or have not done enough upon reaching towards the end of our lives. By then, we may be grappling with our bodily symptoms and often must fight against time to fulfil each of our wishes to find our desired good closure.
Covid-19 has given us some time to reflect and be curious about how we want our final days to be - we can then work towards accepting it as a way of life and finding peace within ourselves. Seek closure and resolution of earlier experiences that have impacted you and your loved ones significantly today. Share and show your family and friends your love and wishes for them, do the things that make you feel at peace. Having good end-of-life conversations would allow our loved ones to feel comforted and assured that they had done enough and this would aid them to feel and heal better during the grieving process.
* The contributor is a Senior Counsellor at Hua Mei Counselling and Coaching, Tsao Foundation. This article was first published in full on My Mental Health site by Agency for Integrated Care on 26 November 2020. The article has been shortened for the Longevity Times. For full article, please go to https://stayprepared.sg/mymentalhealth/articles/preparing-for-a-good-death-saying-goodbye/ .
